Public health professionals in Nicaragua report concerns for a regional epidemic of renal disease. Surveillance data from the Nicaraguan Ministry of Health (Ministerio De Salud Republica de Nicaragua - MINSA) lists renal insufficiency (RI) as the primary cause of death in municipalities on the pacific coast of the country. Preliminary research suggests a high prevalence amongst males less than 60 years of age, as well as an association between RI, and agricultural work and consumption of an unregulated form of alcohol. In order to better describe the situation the University of North Carolina (UNC) Kidney Center, La Universidad Nacional Autsnoma de Nicaragua, Lesn (UNAN- Lesn), and its Centro de Investigacisn en Demografma y Salud (CIDS) have formed an alliance and devised a three year, two phase investigation strategy. In year 1 of the 3-year grant, the first phase will include a cross sectional screening of 1,500 community members randomly selected from representative clusters within Lesn, Nicaragua's population for kidney disease through measurement of serum creatinine and urine albumin and creatinine. The aim of this phase of the study is to determine the prevalence of disease in the effected region. In years 2 and 3 of the grant, phase two will include a nested case-control study among those screened in the first phase of the study. This will include a follow-up screening for kidney disease and a detailed inventory of postulated risk factors in an estimated 150 kidney disease cases and 300 controls. The specific aims for this portion of the study are to determine if the following factors are associated with kidney disease: 1) type and duration of farming 2) consumption of locally made sugar cane-based alcohol;and 3) type of primary water sources. A working collaboration has been established and our proposed two-phase research plan is a critical step to identify if indeed there is a high prevalence of kidney disease in Nicaragua, and to reveal modifiable risk factors which would aid prevention efforts in one of the poorest countries in Central America. Nicaraguans have limited access to healthcare and maintenance therapy for kidney failure (dialysis and transplantation) is not commonly available. This grant will provide the foundation for future research into the understanding, prevention and management of kidney disease in Nicaragua, an endeavor that will be initiated and conducted by CIDS. PUBLIC HEALTH RELEVANCE: This is a collaborative research project between U.S. investigators at the University of North Carolina at Chapel Hill, North Carolina and the Center for Demographic and Health Research in Nicaragua to study kidney disease in Nicaragua. Nicaragua is one of the poorest countries in the Americas. There is some early evidence that there is a high rate of kidney disease in Nicaragua, a country with little access to health care for treatment, including almost no availability of dialysis (a treatment critical to sustain life when the kidneys completely fail). This research will provide the first proper estimates of kidney disease in Nicaragua and will also determine if several environmental and occupational exposures, use of homemade alcohol, and types of water sources are associated with kidney disease. Understanding these associations can have a large impact in reducing kidney disease in the area since these types of exposures can be modified through education and government regulation.